Alex Zozula

EM/EMS doc @BJC_HealthCare Alton Memorial / @UCEmergencyEMS @StanfordEMED alum

[Alex Zozula @azozula]

https://t.co/A9YtHhaOY4 Not the best PR @ESO_Solutions

[Alex Zozula @azozula]

@DrJeffJarvis @EmsLighthouse Not sure if you've seen @First10EM's discussion on WOMAN https://t.co/BS7VFf8NK0 but I share his concern when overall mortality shows no difference. ACOG's position statement is "consider" -- these guidelines seem to strengthen that rec without new data.

[Alex Zozula @azozula]

@EmsLighthouse @DrJeffJarvis Could be wrong but I don't think IV TXA is FDA approved for PPH though PO is for menstrual bleeding.

[Alex Zozula @azozula]

@EmsLighthouse @DrJeffJarvis Appreciate the nuanced discussion of TXA here but still think the EMS guidelines are overstated. WOMAN was negative for the 1⁰ outcome and disease-specific mortality is a fraught 2⁰ outcome. That there's little else to offer in many EMS systems isn't a compelling argument IMO.

[Alex Zozula @azozula]

@ABEMCert Your new portal isn't exactly mobile friendly. The submit buttons are hidden on pretty much every page...

[Alex Zozula @azozula]

Was any methodologist involved in the grading of evidence/drafting of this guideline? This goes further than the original ACOG position statement.

[Alex Zozula @azozula]

@NAEMSP @acog Just reviewed your new model prehospital PPH guidelines and disappointed to see the overstated evidence for TXA. WOMAN was a negative trial. "Evidence-based recommendations for this patient population..." is a nonsensical statement given the best available evidence.

[StanfordEM @StanfordEMED]

What does it mean to be a doctor in a war zone? Stanford faculty member, Dr. Ayesha Khan, shares a gripping personal account of treating patients in Gaza.

🔗 Read more - https://t.co/PJBOKnXzN8

[Alex Zozula @azozula]

@DOGE_FAA It's 2025. These should be required in medical kits.

[Alex Zozula @azozula]

@FlyFrontier The FAA may not require pulse oximeters, but you certainly are allowed to stock more than the bare minimum. Lmk if you need help picking some out.

[Alex Zozula @azozula]

@BMorshediMD @NAEMSP @NicholeBosson @benabo @JLyngEMSMD Really liked this but the discussion of fluids neglected the fairly abundant data on balanced fluids vs. NS in medical hyperK (summarized by @PulmCrit a decade ago at this point https://t.co/8IFvxdf3l1). Also if the *trivial* K in LR is a concern, blood products would be 💀.

[Alex Zozula @azozula]

@swil_ems Certainly reasonable to try though lifesaving for epistaxis may be overstating the evidence just a tad.

[Alex Zozula @azozula]

@AlanPlotzker But if you don't get daily labs, how can you completely ignore expected variation and comment on meaningless trends from one day to the next? That sodium went from 135 to 134. Someone had better take notice!

[Alex Zozula @azozula]

@TheResusRoom @laing_simon @robfenwick @heli_med_james @TRRevents @SJTREM Loved the episode and I recognize that many guidelines haven't caught up, but I'm not sure I agree with avoiding LR or other potassium containing fluids. I'm reminded of an excellent post by @PulmCrit from almost 10y ago on fluid choices for hyperkalemia.

[Alex Zozula @azozula]

@AlanPlotzker What's the lit on (non-febrile) seizures and otherwise asymptomatic bacteruria? I've never seen anything particularly compelling and the problem I have is that people often reflexively get started on beta lactams which are known to increase the chance of having another seizure...

[Alex Zozula @azozula]

@AlanPlotzker @dfreedman7 @phil_bilodeau I'm not sure that's necessarily true. I think many just tire of the same discussion time after time and just order it, especially in places where neuro is either seeing the patient right away or admitting primarily.

[Alex Zozula @azozula]

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Seems ripe for a larger, more definitive trial to really settle the issue one way or the other. It's not a particularly rare condition that's difficult to study...

[Alex Zozula @azozula]

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Never got to play with ibutilide in residency ☹️. https://t.co/nLLq4wJfBN would suggest it's better/faster than procainamide but then you have studies like https://t.co/3kCvyR21jX that suggest it's no better/faster than amio. Too many different seemingly random dosing regimens...

[Alex Zozula @azozula]

@alvarezzzy @EMHighAK @elewMD @TheShenger @drjgutt @SkylerLentz @sreeja_natesan @MprizzleER @kaynani32 @MikePallaci @Chris_McStay @NotSoLilMD @ShehniNadeem @ResusOne @DaveLewMD @davidcarr333 @MRamzyDO Compared to electricity, sure. Compared to amio though...
https://t.co/hqmD7a7PeM

[Alex Zozula @azozula]

@alvarezzzy Miss you guys too! Interestingly they're both $250 at Kaiser...and at VMC, a BMP is $651 but a CMP is $390. Gotta love American "healthcare"!